Provider Demographics
NPI:1609503754
Name:JASKOLKA, SERENA MAE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:MAE
Last Name:JASKOLKA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1949
Mailing Address - Country:US
Mailing Address - Phone:508-951-4482
Mailing Address - Fax:
Practice Address - Street 1:20 MAITLAND ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3534
Practice Address - Country:US
Practice Address - Phone:603-410-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist